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Abnormal oral glucose tolerance tests in first episode, drug naive patients with schizophrenia
3. Epidemiology
51
Arch Gen Psychiatry 2001;58(7):663-8.2. Lieb R, Isensee B, von Sydow K, Wittchen HU. The Early Developmental Stages of Psychopathology Study (EDSP): a methodological update. Eur Addict Res 2000;6(4): 170-82.
ABNORMAL ORAL GLUCOSE TOLERANCE TESTS IN FIRST EPISODE, DRUG NAIVE PATIENTS WITH SCHIZOPHRENIA L. M. S p e l m a n , * R I. Walsh, J. H. T h a k o r e Neuroscience Centre, St Vincents Hospital, Dublin 3, Ireland To determine the prevalence and correlates of impaired glucose tolerance in patients with first episode, drug naive schizophrenia. In this cross-sectional study, an oral glucose tolerance test was per~brmed on 31 hospitalised drug naive Caucasian patients (mean age 31.6+13.3 years) (23 males and 8 females), with DSM-IV schizophrenia and a healthy control group matched for age, sex and body mass index (BMI). Fasting and two-hour glucose and insulin and 8am cortisol were measured. Insulin resistance was calculated using homeostasis model assessment. Diet and exercise were evaluated with validated questionnaires. Anthropometric measurements documented included BMI, waist circumference and waist to hip ratio. Severity of illness was rated using the BPRS and SANS. 2 patients had diabetes mellitus and 6 had impaired glucose tolerance as compared to no cases in the control group (Z2=9.18, dfl=12, p_.0.02). Between patients and controls there was no difference in fasting glucose (84.9+11.4 mg/dL vs. 84.2-+9 mg/dL, respectively; t=0.31, dr=60, p1=0.75, 95% CI-4.42 to+6.0) and fasting insulin (0.49-+0.3 uU/ml vs. 0.39-+0.2 uU/ml, respectively; t=1.69, df=60, p=0.09, 95% CI-0.02 to +0.21). There was a statistically significant difference between patients and controls in two-hour glucose (121.4-+50 mg/dL vs. 85.8-+17.5 mg/dL, respectively; t=3.7, df=60, p _<0.001, 95% CI 16.5 to 54.7) and in two-hour insulin (3.5-+3.7 uU/ml vs. 1.1-+0.5 uU/ml, respectively; t=3.6, df=60, p _<0.001, 95% CI 1.09 to 3.8). Patients were no more insulin resistant than controls (1.85-+1.3 vs. 1.38+0.67, respectively; t=1.75, df=60, p=0.08, 95% C 1 - 0 . 0 6 to +0.99). However, patients had statistically significant higher morning cortisol levels than controls (344.7-+152 nmol/L vs. 250.6-+70 nmol/L, respectively; t=3.12, df=60, p<0.005, 95% C133.8 to 154.4). In the patient group, two-hour glucose correlated positively with age (r=0.49, df=29, p_<0.005) and BMI (r=-0.54, df=29, p_<0.005), though not with severity of illness (r=-0.024, df=29, p=0.89) and plasma cortisol (r=0.256, df=29, p=0.16). Drug-naive, first episode schizophrenia patients are more likely to have diabetes mellitus or impaired glucose tolerance and have higher levels of glucose, insulin and cortisol than a healthy control group. Increasing age and BMI, but not illness severity or cortisol, are positively correlated with plasma glucose.
CRIMINALITY IN THE HELSINKI HIGH-RISK STUDY J. M. Suvisaari,* L. T. Niemi, J. K. H a u k k a , J. K. L 6 n n q v i s t Department of Mental Health and Alcohol Research, National Public Health Institute, Finland, Helsinki, Finland We investigated whether offspring of mothers with psychotic disorders are at increased risk of criminality. The Helsinki High-Risk (HR) Study sample comprises all females born between 1916 and 1948 who had been treated in mental hospitals in Helsinki with a hospital
diagnosis of schizophrenia spectrum psychosis, and who had given birth in Helsinki to offspring born between 1960 and 1964. Controls are the previous same-sex births from the same maternity hospitals. Data on psychiatric morbidity for both parents and offspring in the HR and control groups were obtained from the Finnish Hospital Discharge Register. Based on the register information, all hospital and outpatient treatment records were collected and rated according to DSM-IV criteria. The final HR group consisted of 104 offspring of mothers with schizophrenia, 50 offspring of mothers with other schizophrenia spectrum disorders, and 25 offspring of mothers with major affective disorders. Data on criminal convictions until December 31, 2000 were obtained from the Finnish Central Criminal Register maintained by the Ministry of Justice. 13 of the HR offspring (7.3%) and five of the 176 controls (2.8%) had a criminal record (chisquare d.f.=l P=0.06). Six of the HR offspring (3.4%) and two of the controls (1.1%) had committed a violent offence (chi-square d.f.=l P=0. t 6). In the schizophrenia HR group, nine offspring (8.7%) had a criminal record (chi-square d.f.=l P=0.036), and five (4.8%) had committed a violent offence (chi-square d.f.=l P=0.06). We conclude that offspring of mothers with schizophrenia are at increased risk of criminal offending. Acknowledgements: This study was supported by the Stanley Medical Research Institute. J.S. was supported by the Finnish Cultural Foundation.
SUICIDE ATTEMPTS AND FAMILY HISTORY OF SUICIDE IN SCHIZOPHRENIA E T r e m e a u , * R Czobor, L. Staner, H. Con'ea, J. R M a c h e r Nathan Kline Institute, Orangeburg, NY,, USA The influence of a family history (FH) of suicide on suicide attempt (SA) characteristics in individuals with schizophrenia was examined. In addition, SA characteristics between patients with schizophrenia, unipolar depression or opioid-dependence were compared. 160 inpatients with schizophrenia, 160 inpatients with unipolar depression and 160 outpatients in a methadone maintenance program were interviewed for SA and FH of suicide. Fifty percent of patients with schizophrenia had a history of SA. Of these, the mean age at first SA was 24.3 (SD: 8.8), 44% made more than one attempt, and 51% had used a method of high lethality at least once. Compared to female patients with schizophrenia, male patients with schizophrenia had similar rates of SA, but they made their first SA at an earlier age. The risk for attempting suicide among the patients with schizophrenia with a FH of suicide was more than 3 times higher than those without a FH. A FH for suicide was also associated with earlier age at first attempt, using a method of high lethality and repeated attempts. Similar findings regarding SA characteristics and FH influences were seen among the patients with opioid dependence, but not for patients with unipolar depression. The SA rate of 50% in the patients with schizophrenia was higher than the previously reported rates of 20 to 40% (1). A positive association between FH of suicide and personal history of SA was reported in one study (2), but influences of a FH of suicide on probands SA characteristics have not been reported before. SA in patients with schizophrenia and in opioid dependence share similar characteristics, but this differs from what was observed in patients with unipolar depression. 1. Harkavy-Friedmann JM, Restifo K, Malaspina D, Kaufmann CA, Amador XF, Yale SA, Gorman JM. Suicidal behavior in schizophrenia: characteristics of individuals who had and had not attempted suicide. Am J Psychiatry 1999; 156: 1276-1278.2. RoyA. Family history of suicide. Arch Gen Psychiatry 1983; 40:971-974.
International Congress on Schizophrenia Research 2003
51
Arch Gen Psychiatry 2001;58(7):663-8.2. Lieb R, Isensee B, von Sydow K, Wittchen HU. The Early Developmental Stages of Psychopathology Study (EDSP): a methodological update. Eur Addict Res 2000;6(4): 170-82.
ABNORMAL ORAL GLUCOSE TOLERANCE TESTS IN FIRST EPISODE, DRUG NAIVE PATIENTS WITH SCHIZOPHRENIA L. M. S p e l m a n , * R I. Walsh, J. H. T h a k o r e Neuroscience Centre, St Vincents Hospital, Dublin 3, Ireland To determine the prevalence and correlates of impaired glucose tolerance in patients with first episode, drug naive schizophrenia. In this cross-sectional study, an oral glucose tolerance test was per~brmed on 31 hospitalised drug naive Caucasian patients (mean age 31.6+13.3 years) (23 males and 8 females), with DSM-IV schizophrenia and a healthy control group matched for age, sex and body mass index (BMI). Fasting and two-hour glucose and insulin and 8am cortisol were measured. Insulin resistance was calculated using homeostasis model assessment. Diet and exercise were evaluated with validated questionnaires. Anthropometric measurements documented included BMI, waist circumference and waist to hip ratio. Severity of illness was rated using the BPRS and SANS. 2 patients had diabetes mellitus and 6 had impaired glucose tolerance as compared to no cases in the control group (Z2=9.18, dfl=12, p_.0.02). Between patients and controls there was no difference in fasting glucose (84.9+11.4 mg/dL vs. 84.2-+9 mg/dL, respectively; t=0.31, dr=60, p1=0.75, 95% CI-4.42 to+6.0) and fasting insulin (0.49-+0.3 uU/ml vs. 0.39-+0.2 uU/ml, respectively; t=1.69, df=60, p=0.09, 95% CI-0.02 to +0.21). There was a statistically significant difference between patients and controls in two-hour glucose (121.4-+50 mg/dL vs. 85.8-+17.5 mg/dL, respectively; t=3.7, df=60, p _<0.001, 95% CI 16.5 to 54.7) and in two-hour insulin (3.5-+3.7 uU/ml vs. 1.1-+0.5 uU/ml, respectively; t=3.6, df=60, p _<0.001, 95% CI 1.09 to 3.8). Patients were no more insulin resistant than controls (1.85-+1.3 vs. 1.38+0.67, respectively; t=1.75, df=60, p=0.08, 95% C 1 - 0 . 0 6 to +0.99). However, patients had statistically significant higher morning cortisol levels than controls (344.7-+152 nmol/L vs. 250.6-+70 nmol/L, respectively; t=3.12, df=60, p<0.005, 95% C133.8 to 154.4). In the patient group, two-hour glucose correlated positively with age (r=0.49, df=29, p_<0.005) and BMI (r=-0.54, df=29, p_<0.005), though not with severity of illness (r=-0.024, df=29, p=0.89) and plasma cortisol (r=0.256, df=29, p=0.16). Drug-naive, first episode schizophrenia patients are more likely to have diabetes mellitus or impaired glucose tolerance and have higher levels of glucose, insulin and cortisol than a healthy control group. Increasing age and BMI, but not illness severity or cortisol, are positively correlated with plasma glucose.
CRIMINALITY IN THE HELSINKI HIGH-RISK STUDY J. M. Suvisaari,* L. T. Niemi, J. K. H a u k k a , J. K. L 6 n n q v i s t Department of Mental Health and Alcohol Research, National Public Health Institute, Finland, Helsinki, Finland We investigated whether offspring of mothers with psychotic disorders are at increased risk of criminality. The Helsinki High-Risk (HR) Study sample comprises all females born between 1916 and 1948 who had been treated in mental hospitals in Helsinki with a hospital
diagnosis of schizophrenia spectrum psychosis, and who had given birth in Helsinki to offspring born between 1960 and 1964. Controls are the previous same-sex births from the same maternity hospitals. Data on psychiatric morbidity for both parents and offspring in the HR and control groups were obtained from the Finnish Hospital Discharge Register. Based on the register information, all hospital and outpatient treatment records were collected and rated according to DSM-IV criteria. The final HR group consisted of 104 offspring of mothers with schizophrenia, 50 offspring of mothers with other schizophrenia spectrum disorders, and 25 offspring of mothers with major affective disorders. Data on criminal convictions until December 31, 2000 were obtained from the Finnish Central Criminal Register maintained by the Ministry of Justice. 13 of the HR offspring (7.3%) and five of the 176 controls (2.8%) had a criminal record (chisquare d.f.=l P=0.06). Six of the HR offspring (3.4%) and two of the controls (1.1%) had committed a violent offence (chi-square d.f.=l P=0. t 6). In the schizophrenia HR group, nine offspring (8.7%) had a criminal record (chi-square d.f.=l P=0.036), and five (4.8%) had committed a violent offence (chi-square d.f.=l P=0.06). We conclude that offspring of mothers with schizophrenia are at increased risk of criminal offending. Acknowledgements: This study was supported by the Stanley Medical Research Institute. J.S. was supported by the Finnish Cultural Foundation.
SUICIDE ATTEMPTS AND FAMILY HISTORY OF SUICIDE IN SCHIZOPHRENIA E T r e m e a u , * R Czobor, L. Staner, H. Con'ea, J. R M a c h e r Nathan Kline Institute, Orangeburg, NY,, USA The influence of a family history (FH) of suicide on suicide attempt (SA) characteristics in individuals with schizophrenia was examined. In addition, SA characteristics between patients with schizophrenia, unipolar depression or opioid-dependence were compared. 160 inpatients with schizophrenia, 160 inpatients with unipolar depression and 160 outpatients in a methadone maintenance program were interviewed for SA and FH of suicide. Fifty percent of patients with schizophrenia had a history of SA. Of these, the mean age at first SA was 24.3 (SD: 8.8), 44% made more than one attempt, and 51% had used a method of high lethality at least once. Compared to female patients with schizophrenia, male patients with schizophrenia had similar rates of SA, but they made their first SA at an earlier age. The risk for attempting suicide among the patients with schizophrenia with a FH of suicide was more than 3 times higher than those without a FH. A FH for suicide was also associated with earlier age at first attempt, using a method of high lethality and repeated attempts. Similar findings regarding SA characteristics and FH influences were seen among the patients with opioid dependence, but not for patients with unipolar depression. The SA rate of 50% in the patients with schizophrenia was higher than the previously reported rates of 20 to 40% (1). A positive association between FH of suicide and personal history of SA was reported in one study (2), but influences of a FH of suicide on probands SA characteristics have not been reported before. SA in patients with schizophrenia and in opioid dependence share similar characteristics, but this differs from what was observed in patients with unipolar depression. 1. Harkavy-Friedmann JM, Restifo K, Malaspina D, Kaufmann CA, Amador XF, Yale SA, Gorman JM. Suicidal behavior in schizophrenia: characteristics of individuals who had and had not attempted suicide. Am J Psychiatry 1999; 156: 1276-1278.2. RoyA. Family history of suicide. Arch Gen Psychiatry 1983; 40:971-974.
International Congress on Schizophrenia Research 2003